Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years

Paula, Jayter Silva; Furtado, João M.; Santos, Arles Silva; Coelho, Roberto de Mattos; Rocha, Eduardo Melani; Rodrigues, Maria de Lourdes Veronese

doi:10.1590/s0004-27492012000400004

Cited by 17 publications

(13 citation statements)

References 21 publications

(23 reference statements)

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“…However, only 195 of these patients were followed from the time of their initial diagnosis. Furtado et al 39 reported on the risk of blindness from primary open angle glaucoma in a tertiary care hospital in Brazil in patients with at least 15 years of follow-up. Their patients had a 24.5% risk of unilateral and 34% risk of bilateral blindness at the end of their follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

et al. 2014

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Objective To determine the longitudinal trends in the probability of blindness due to open-angle glaucoma (OAG) in Olmsted County, Minnesota from 1965 to 2009. Design Retrospective, population-based cohort study. Participants All residents of Olmsted County, Minnesota (40 years of age and over) who were diagnosed with OAG between January 1, 1965 to December 31, 2000. Methods All available medical records of every incident case of OAG were reviewed until December 31, 2009 to identify progression to blindness, defined as visual acuity of 20/200 or worse, and/or visual field constriction to 20° or less. Kaplan–Meier analysis was used to estimate the cumulative probability of glaucoma-related blindness. Population incidence of blindness within 10 years of diagnosis was calculated using United States Census data. Rates for subjects diagnosed in the period 1965–1980 were compared with rates for subjects diagnosed in the period 1981–2000 using logrank tests and Poisson regression models. Main Outcome Measures Cumulative probability of OAG-related blindness, and population incidence of blindness within 10 years of diagnosis. Results Probability of glaucoma-related blindness in at least one eye at 20 years decreased from 25.8 % (95% Confidence interval [CI]: 18.5–32.5) for subjects diagnosed in 1965–1980, to 13.5% (95% CI: 8.8–17.9) for subjects diagnosed in 1981–2000 (P=0.01). The population incidence of blindness within 10 years of the diagnosis decreased from 8.7 per 100,000 (95% CI: 5.9–11.5) for subjects diagnosed in 1965–1980, to 5.5 per 100,000 (95% CI: 3.9–7.2) for subjects diagnosed in 1981–2000 (P=0.02). Higher age at diagnosis was associated with increased risk of progression to blindness (P< 0.001). Conclusions The 20-year probability and the population incidence of blindness due to OAG in at least one eye have decreased over a 45 year period from 1965 to 2009. However, a significant proportion of patients still progress to blindness despite recent diagnostic and therapeutic advancements.

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Section: Discussionmentioning

confidence: 99%

Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

et al. 2014

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“…6–8 Patients who do not consistently take their medications risk periods of uncontrolled intraocular pressure which can result in glaucomatous progression; patients with poor adherence have more severe glaucomatous damage, 9–11 and poor adherence is an important risk factor for blindness from glaucoma. 12–15 …”

Section: Introductionmentioning

confidence: 99%

Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up

et al. 2015

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Purpose To assess longer-term patterns of glaucoma medication adherence and identify whether patterns of adherence established during the first year of medication use persist during three subsequent years of follow-up. Design Retrospective longitudinal cohort analysis. Participants Beneficiaries ≥40 years old enrolled in a U.S. managed care plan for ≥7 years between 2001-2012 newly diagnosed and treated for open-angle glaucoma. Methods For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to all enrollees to look for similar patterns of adherence for groups of enrollees. These patterns were described for 1 and 4 years of follow-up and analyses were performed to identify persons who experienced similar adherence patterns at 1 and 4 years and others who had dissimilar patterns. Factors impacting adherence at 1 and 4 years were identified using regression analyses. Main Outcome Measure Patterns of glaucoma medication adherence. Results Of the 1,234 eligible beneficiaries, GBTM identified five distinct glaucoma medication adherence patterns in both the one-year and four-year follow-up periods. These groups were: 1) Never adherent after their index prescription fill (7.5%,15.6% of persons in the one and four-year models, respectively); 2) Persistently very poor adherence (14.9%, 23.4%); 3) Declining adherence (9.5%, 9.1%); 4) Persistently moderate adherence (48.1%, 37.0%); and 5) Persistently good adherence (20.0%, 15.0%). Over 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (Groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up while those with Persistently moderate adherence (Group 4) – the largest sized group-were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, older age, earn >$60,000/year, and have more eye care visits (p<0.05 for all comparisons). Those with a higher initial co-payment cost had lower adherence rates (β=−0.06/dollar, p=0.03). Conclusion For most patients newly-started on glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

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“…6, 7 Poor adherence has been shown to be associated with disease progression and blindness. 8–11 In order to improve the clinical management of glaucoma, it is critically important to understand the reasons that glaucoma patients do not adhere to their medications.…”

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confidence: 99%

The Most Common Barriers to Glaucoma Medication Adherence

Newman-Casey¹,

Robin²,

Blachley³

et al. 2015

Ophthalmology

329

266

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Purpose To both evaluate the frequency of eleven commonly cited barriers to optimal glaucoma medication adherence among glaucoma patients and identify barriers contributing to poor adherence. Design Prospective, cross-sectional survey. Participants 190 adults with glaucoma taking ≥1 glaucoma medication who received care in glaucoma clinics in Ann Arbor, MI and Baltimore, MD. Methods Participants completed a survey on demographic and disease characteristics, barriers to optimal glaucoma medication adherence, interest in an eye drop aid, and self-reported adherence (measured by the Morisky Adherence Scale). Descriptive statistics and logistic regression analyses were performed. Main Outcome Measures Frequency and number of barriers to adherence among both adherent and non-adherent patients. Odds ratios with 95% confidence intervals identifying barriers associated with poor adherence. Results 27% of the sample reported poor adherence. 61% of all participants cited multiple barriers and 10% cited a single barrier as impediments to optimal adherence. 29% of subjects cited no barriers, though only 13% of patients who cited no barriers were non-adherent. Among non-adherent patients, ≥31% cited each of the eleven barriers as important. Logistic regression analysis, adjusted for age, revealed that the following barriers were associated with higher odds of non-adherence: decreased self-efficacy, OR = 4.7 [95% CI 2.2–9.7, p= < 0.0001]; difficulty instilling drops, OR = 2.3 [95% CI 1.1–4.9, p= 0.03]; forgetfulness, OR = 5.6 [95% CI 2.6–12.1, p= < 0.0001]; and difficulties with the medication schedule, OR = 2.9 [1.4–6.0, p= 0.006]. For each additional barrier cited as important, there was a 10% increased odds of being non-adherent, OR = 1.1 [95% CI 1.0–1.2, p= 0.01]. Conclusion Each of the eleven barriers was important to at least 30% of surveyed patients with poor adherence, with the majority identifying multiple barriers to adherence. Low self-efficacy, forgetfulness, and difficulty with drop administration and the medication schedule were all barriers associated with poor adherence. Interventions to improve medication adherence must address each patient’s unique set of barriers.

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Risk factors for blindness in patients with open-angle glaucoma followed-up for at least 15 years

Cited by 17 publications

References 21 publications

Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

Long-Term Trends in Glaucoma-Related Blindness in Olmsted County, Minnesota

Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up

The Most Common Barriers to Glaucoma Medication Adherence

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